New Advances in Monitoring Cardiac Output in Circulatory Mechanical Assistance Devices. A Validation Study in a Porcine Model

Quintana‐Villamandos, Begoña; Barranco, Mónica; Fernández, Ignacio; Ruíz, Manuel; Cañizo, Juan F. Del

doi:10.3389/fphys.2021.634779

Cited by 3 publications

(7 citation statements)

References 44 publications

(59 reference statements)

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“…PAC is still recommended by the interdisciplinary S3 guidelines in a cardiac surgical setting, and this indication includes patients with LVADs (Kanchi, 2011;Habicher et al, 2018). Continuous thermodilution by PAC has been validated in both continuous-flow (Quintana-Villamandos et al, 2021) and pulsatile-flow (Mets et al, 2002) LVADs, because it is crucial to know the status of end-organ perfusion in these patients (Birati and Rame, 2014). In a previous study, our group has Frontiers in Physiology frontiersin.org validated continuous thermodilution by PAC using intermittent thermodilution by PAC (standard technique), in six minipigs with continuous-flow LVADs (Quintana-Villamandos et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

“…We use six healthy mini-pigs with a mean weight of 42.8 ± 9.9 kg. The previously described anesthetic protocol was applied (Morillas-Sendín et al, 2015;Quintana-Villamandos et al, 2021). After premedication with 20 mg/kg intramuscular ketamine (Ketolar, Parke-Davis, Madrid, Spain) and 0.04 mg/kg atropine (Atropina Braun, Serra Pamies, Reus, Spain), anesthesia was induced with 2.5 μg/kg intravenous fentanyl (Fentanest, Kern Pharma, Barcelona, Spain) and 4 mg/kg propofol (Diprivan 1%, AstraZeneca, Madrid, Spain).…”

Section: Anaesthesia and Surgical Protocolmentioning

confidence: 99%

“…The established surgical protocol was applied (Morillas-Sendín et al, 2015;Quintana-Villamandos et al, 2021). A Biomedicus 540 centrifugal pump was implanted in the minipigs undergoing continuous-flow support.…”

Section: Anaesthesia and Surgical Protocolmentioning

confidence: 99%

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Cardiac output monitoring with pulmonary versus trans-cardiopulmonary thermodilution in left ventricular assist devices: Interchangeable methods?

et al. 2022

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Cardiac output (CO) measurement is mandatory in patients with left ventricular assist devices (LVADs). Thermodilution with pulmonary artery catheter (PAC) remains the clinical gold standard to measure CO in these patients, however it is associated with several complications. Therefore, the agreement between PAC and new, minimally invasive monitoring methods in LVAD needs to be further investigated. The aim of this study was to assess the accuracy and reliability of transpulmonary thermodilution with a PiCCO2 monitor compared with pulmonary artery thermodilution with PAC in a LVAD. Continuous-flow LVADs were implanted in six mini-pigs to assist the left ventricle. We studied two methods of measuring CO—intermittent transpulmonary thermodilution (COTPTD) by PiCCO2 and intermittent pulmonary artery thermodilution by CAP, standard technique (COPTD)—obtained in four consecutive moments of the study: before starting the LVAD (basal moment), and with the LVAD started in normovolemia, hypervolemia (fluid overloading) and hypovolemia (shock hemorrhage). A total of 72 paired measurements were analysed. At the basal moment, COTPTD and COPTD were closely correlated (r2 = 0.89), with a mean bias of −0.085 ± 0.245 L/min and percentage error of 16%. After 15 min of partial support LVAD, COTPTD and COPTD were closely correlated (r2 = 0.79), with a mean bias of −0.040 ± 0.417 L/min and percentage error of 26%. After inducing hypervolemia, COTPTD and COPTD were closely correlated (r2 = 0.78), with a mean bias of −0.093 ± 0.339 L/min and percentage error of 13%. After inducing hypovolemia, COTPTD and COPTD were closely correlated (r2 = 0.76), with a mean bias of −0.045 ± 0.281 L/min and percentage error of 28%. This study demonstrates a good agreement between transpulmonary thermodilution by PiCCO monitor and pulmonary thermodilution by PAC in the intermittent measurement of CO in a porcine model with a continuous-flow LVAD.

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Section: Discussionmentioning

confidence: 99%

Section: Anaesthesia and Surgical Protocolmentioning

confidence: 99%

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Cardiac output monitoring with pulmonary versus trans-cardiopulmonary thermodilution in left ventricular assist devices: Interchangeable methods?

et al. 2022

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“…24 A new generation of PACs can allow for continuous CO measurement. 25 This new technology utilizes heat instead of cold thermodilution via a thermal filament connected to a specialized PAC and a distal thermistor. 25 However, this new generation PACs is still not available at our unit.…”

Section: Discussionmentioning

confidence: 99%

“…25 This new technology utilizes heat instead of cold thermodilution via a thermal filament connected to a specialized PAC and a distal thermistor. 25 However, this new generation PACs is still not available at our unit. Several less invasive commercial devices for continuous cardiac output based on arterial waveform are currently available PiCCO (pulse contour cardiac output), LiDCO (lithium dilution cardiac output) and flowtrac/vigileo system).…”

Section: Discussionmentioning

confidence: 99%

Anaesthesia for liver transplantation at King Hussein medical centre: an overview of 70 cases

et al. 2021

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Background: To review the indications, patients' demographics, and anaesthetic protocol and to analyze perioperative complications of liver transplantation surgery.Methods: Retrospective analysis of 70 cases of LT in the period between June 2004 and October 2020 at King Hussein medical centre. Preoperative factors such as patients' demographics, age, gender, etiology of hepatic pathology, laboratory investigations, model for end-stage liver disease scores, duration of surgery and type of liver donation were recorded. Intraoperative factors such as anaesthetic and surgical protocols, need of blood product transfusions and haemodynamic monitoring were analyzed. Postoperative tracking of patients' complications and outcomes was done.Results: 68 living donor and two cadaveric LT procedures. Male to female ratio was 2.9:1.The age of LT recipients ranged from 3 to 62 years with an average age of 38.45 years. Their body weights ranged from 13 to 100 kg with mean body weight of 67.03 kg. Most common indication was cryptogenic liver cirrhosis (21.4%), followed by cirrhosis due to viral hepatitis B (15.7%). Autoimmune hepatitis was an indication in 11.4% and hepatitis C liver cirrhosis in 10%. All living donors were closely related. Right hepatic lobe graft was used in 85.7% of transplantations. Average red cells concentrate (RCC) transfused (units) was 3.1±3.97 (mean±SD). Duration of surgery (hours) was 12.5±2.4 (mean±SD). Fast track LT with extubation in theatre was done in 37 LT recipients (52.9%). Readmission to operative theatre was needed in 5 recipients (7.14%). Most common long term complications were biliary leak (20%), biliary stenosis (14.2%) and recurrence of primary disease (12.9%).Conclusions: Transplantation from living donors was by far more common in our study population. Majority of recipients were male and cryptogenic liver cirrhosis was the most common indication. Right hepatic lobe graft was used mostly. Biliary leak was the most common postoperative complication. Surgical time duration and blood products transfusion decreased significantly over years since the start of LT program.

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Oxygen Consumption Predicts Long-Term Outcome of Patients with Left Ventricular Assist Devices

et al. 2023

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Reduced oxygen consumption (VO2), either due to insufficient oxygen delivery (DO2), microcirculatory hypoperfusion and/or mitochondrial dysfunction, has an impact on the adverse short- and long-term survival of patients after cardiac surgery. However, it is still unclear whether VO2 remains an efficient predictive marker in a population in which cardiac output (CO) and consequently DO2 is determined by a left ventricular assist device (LVAD). We enrolled 93 consecutive patients who received an LVAD with a pulmonary artery catheter in place to monitor CO and venous oxygen saturation. VO2 and DO2 of in-hospital survivors and non-survivors were calculated over the first 4 days. Furthermore, we plotted receiver-operating curves (ROC) and performed a cox-regression analysis. VO2 predicted in-hospital, 1- and 6-year survival with the highest area under the curve of 0.77 (95%CI: 0.6–0.9; p = 0.0004). A cut-off value of 210 mL/min VO2 stratified patients regarding mortality with a sensitivity of 70% and a specificity of 81%. Reduced VO2 was an independent predictor for in-hospital, 1- and 6-year mortality with a hazard ratio of 5.1 (p = 0.006), 3.2 (p = 0.003) and 1.9 (p = 0.0021). In non-survivors, VO2 was significantly lower within the first 3 days (p = 0.010, p < 0.001, p < 0.001 and p = 0.015); DO2 was reduced on days 2 and 3 (p = 0.007 and p = 0.003). In LVAD patients, impaired VO2 impacts short- and long-term outcomes. Perioperative and intensive care medicine must, therefore, shift their focus from solely guaranteeing sufficient oxygen supply to restoring microcirculatory perfusion and mitochondrial functioning.

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New Advances in Monitoring Cardiac Output in Circulatory Mechanical Assistance Devices. A Validation Study in a Porcine Model

Cited by 3 publications

References 44 publications

Cardiac output monitoring with pulmonary versus trans-cardiopulmonary thermodilution in left ventricular assist devices: Interchangeable methods?

Cardiac output monitoring with pulmonary versus trans-cardiopulmonary thermodilution in left ventricular assist devices: Interchangeable methods?

Anaesthesia for liver transplantation at King Hussein medical centre: an overview of 70 cases

Oxygen Consumption Predicts Long-Term Outcome of Patients with Left Ventricular Assist Devices

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